“POLSTs” More Explicit and Binding than Problematic, Vague DNR Orders

“Do Not Resuscitate” (DNR) orders only apply to situations of cardiac arrest. According to the NYS Department of Health, DNR orders have no application to any other medical situation or treatment. That is not always clear, however. As a result, DNR orders are sometimes relied on by medical professionals’ to suggest patients’ wishes in situations other than cardiac arrest. Moreover, a patient could have a DNR order because she suffers from a chronic illness, yet if she were in a car accident, and the resulting injuries required life-sustaining treatment, she may not want the DNR to apply.

In answer to the problems created by DNRs, almost all of the states in the U.S. have adopted or are in the process of adopting “physician order[s] for life-sustaining treatment” (POLSTs). (NY uses a comparable form called a MOLST (Medical Orders for Life-Sustaining Treatment.) POLSTs are more explicit than DNRs, and they specify “a patient’s goals and desires as death closes in.” A POLST must be signed by a doctor or other medical professional, and in most states the patient or a designated surrogate must sign also. Yet, in states such as New York and Oregon, the patient does not have to sign. Some disability advocates argue that patients’ signatures should be required in order to signal full consent. Read more here.

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The pieces here represent the position and analysis of the individual authors and not those of the Hofstra Bioethics Center or The Gitenstein Institute for Health Law & Policy. Each author is responsible for the accuracy of the citations and substance of the text itself.